Background and aims: Extracorporeal membrane oxygenation is a high-risk and low-volume procedure whose management requires quick and decisive application of knowledge as well as technical and behavioral prowess to solve multiple problems. A variety of simulation modalities can facilitate the learning of procedural skills and promote evidence-based practice guidelines. Aims: 1) To establish a nurse led simulation-based extracorporeal membrane oxygenation education program for CTSD PICU nurses; 2) To evaluate the competency of nursing care for paediatric patients with ECMO therapy. Methods: From September 2012 to December 2013, our department initiated a nurse led simulation-based ECMO education program which was a 1-day in-service training and development. We recruited 45 nurses who were working in CTSD PICU. The program included a pre-test and post-test, ECMO demonstration, return demonstration, case discussion and simulation scenarios. Debriefing introduced after post-test. Evaluation was completed at the end of the program. Results: 45 CTSD PICU nurses were recruited to participate in the program. Pre-test was finished and found that they were lacking knowledge in looking after critically ill paediatric patients with ECMO therapy. In the pre-test, all nurses achieved an average of 47.5% whereas 90% in the post-test. Of 45 nurses who joined the program, 87% enjoyed the program, 88% found it useful, 92% facilitated their professional development and 95% enjoyed the team work with instructors. Conclusions: Nurse led simulation-based ECMO education program proved to be effective and provided a safer clinical ECMO service to enhance better patient outcomes. All nursing staff attained good competency with simulated clinical ECMO management.